pancreas and spleen Flashcards
where does the spleen lie
in the leaf of greater omentum
what attaches the spleen to the stomach
gastrosplenic ligament
nodular lymphoreticular tissue
white pulp
what part of the parenchyma is the site of immune response in the spleen
white pulp
this section of the spleen stores RBC and traps antigens
red pulp = venous sinuses
calcium/iron deposits on the spleen - normal finding
siderotic plaques
accessory spleen
incidental ectopic tissue
usually from seeding of cells after trauma or sx
splenosis
spleen stores ___% RBC and ___% platlets
10-20% RBC
30% plts
T/F
we need the spleen to live
no
symmetric spleen enlargement
splenomegaly -
drug induced
congestion/torsion
immune mediate dz
asymmetric spleen enlargement
masses - neoplasia
hematoma
nodular hyperplasia
splenic torsion is most common with what
GDV
– or stretching of gastrosplenic ligament in previous GDV incident
large giant breed dogs
signs of acute splenic torsion
acute abdomen normally due to gdv pain and shock distension cvs collapse dysrhythmias DIC
signs of chronic splenic torsion
intermittent for 2 weeks vomit and diarrhea anemia hematuria pu/pd
splenic torsion diagnostic test of choice
ultrasound
what will be seen on ultrasound to confirm splenic torsion
diffuse hypoechoic areas
intraluminal echogenic densities in veins
no flow in splenic vessels
what do rads show for splenic torsion
c shaped spleen
mid abdominal mass
effusion
gas bubbles in spleen
definitive tx for splenic torsion
exploratory laparotomy followed by splenectomy
**gastropexy too bc once spleen removed more likely to get gdv
T/F
derotate the spleen before splenectomy
FALSE NEVER DEROTATE THE SPLEEN BEFORE A SPLENECTOMY
T/F
ideally submit the spleen for histopath to ensure no underlying pathology to the torsion
true
survival to discharge of splenic torsion
91%
splenic torsion breed predisposition
GSD
danes
english bulldogs
what is not a cause ever of splenic torsion
neoplasia
need to differentiate tumor from torsion bc both show mass effect on rads
T/F
splenic infarction is an emergency and surgery needs done immediately
false - do not race to surgery, usually infarction is due to a systemic problem, sort that out first
example of a splenic hyperactivity disorder
IMHA - diffuse hyperplasia
diagnostic dilemma with nodular hyperplasia
FNA cytology can look like cancer because there is poor sensitivity
sites of extrameduallary hyperplasia
nodular hyperplasia
T/F
most splenic nodular hyperplasia was an incidental finding and benign
true
rupture of capsule and parenchyma of spleen
blunt force - splenic trauma
how to treat splenic trauma
conservative mgmt
compression bandage
total splenectomy
1 splenic neoplaia in dog
HSA
1 splenic neoplasia in cat
mast cell tumor
what is the rule of 2/3
2/3 of dogs with a splenic mass will be malignant
and 2/3 of those malignancies will be HSA
risk factors for HSA
older
>21 kg
GSD, lab, golden, poodle
presence of hemoperitoneum
presence of hemoperitoneum increases chance of splenic malignancy by what %
> 80%
NOT A RISK FACTOR IN SMALL DOGS THOUGH!!!!!!
why is the px so poor for HSA
nearly all cases have microscoping mets at the time of diagnosis
1-3 months
prognosis of HSA surgery alone
1-3 months
prognosis HSA
surgery + chemo/palladia
5-6 months
1 year in 10% of cases
HSA prognosis in surgery + chemo + immunotherapy
stage 1 (non ruptured spleen) - 425 days
stage 2 (ruptured spleen) - no benefit
alternative adjunctive therapy in hsa
turkey tail mushroom - c versicolor
contains psp which causes cell cycle arrest at the g1/s checkpoint = more apoptosis of cancer cells
complete splenectomy 2 techniques
- ligation of individual hilar vessels
2. ligation of splenic and short gastric arteries
which splenectomy technique preserves branches to the pancreas and stomach
hilar dissection
limit of hemostatic clips
<4 mm vessels
what does LDS stand for
ligate divide stapler
electrothermal bipolar system can handle vessels of what size
up to 7mm without thermal damage
much faster and no foreign material is left behind
most common complication of splenectomy
hemorrhage
iatrogenic complications of splenectomy
pancreatitis/necrosis
gastric wall compromise
if this complication is present post splenectomy there is a 2x higher risk of death
ventricular arrhythmias
monitor with 24 hour telemetry - holtor
what supplies blood to the left limb of the pancreas
branch of splenic a
what supplies blood to the right limb and body of the pancreas
cd pancreaticoduodenal a –> branch of cranial mesenteric a
enters duodenum at the major duodenal papilla with the bile duct
pancreatic duct
**primary/only duct in cats
drains into the duodenum at the minor duodenal papilla in dogs
accessory pancreatic duct
drains the left lobe of the kidney
accessory pancreatic duct
drains the right lobe of the kidney
pancreatic duct
make glucagon
alpha cells
make insulin
beta cells – 60-75% of islet cells
endocrine pancreas is made of what
islet of langerhans
delta cells
somatostatin
f cells
pancreatic polypeptide
T/F
pancreatitis is a very common and surgical disease
false - very common but not surgical
surgical biopsy technique of pancreas if diffuse disease is present
suture fracture - guillotine technique
indications of partial pancreatectomy
tumor removal
what two tools work best for ligations in partial pancreatectomy
hemoclips or bipolar cautery
what percent of the pancreas can be removed if the ramaining ducts are patent
80%
what is the most common and unpredictable complication of a partial pancreatectomy
pancreatitis - warn the owners
what is a complication of partial pancreatectomy if > 80-90% is removed
endocrine pancreatic insufficiency – treat with insulin supplements
dr cavs tool of choice for pancreatic surgery
ligasure – does not cause pancreatitis in its patients
devitilization of duodenum
if the pancreaticoduodenal arety (which arises from the cranial mesenteric artery) is damaged in surgery of the pancreas, the duodenum could be compromised
Collections of pancreatic secretions & cellular debris w/in fibrous sac or wall of granulation tissue
pancreatic pseudocyst
pancreatic pseudocysts lack this feature and therefore they are not true cysts
epithelial walls
T/F
pancreatic pseudocysts are often an incidental finding
true
pancreatic pseudocysts dx test of choice
ultrasound
pancreatic pseudocysts treatrment
only resect if ill from the disease, or debride and omentalize
usually secondary to bouts of pancreatitis
pancreatic abscess
lab results on pancreatic abscess
hyperbilirubinemia
elevated liver enzymes due to EHBO – inflammed pancreas is causing duodenal papilla to swell shut
important to do post op for pancreatic abcess surgery patients
post gastric feeding tube
prognosis in pancreatic abscess patients
poor
exocrine pancreatic adenocarcinoma prognosis
50-78% mets at dx sx resection if possible very poor 3 months in dogs <7 days in cats
insulinoma
beta cells continue to secrete insulin even though hypoglycemic
T/F
insulinoma is 100% malignant
false – 90% but like…
what is whipples triad
way to dx insulinoma
clinical signs associated with hypoglycemia
fasting blood glu of 40 or lower
relief of neuro signs when fed glucose
what is the most diagnostic for insulinoma
fasting insulin-glucose ratio
insulin is HIGH despite hypoglycemia
normal should be 5 to 26
insulinoma insulin levels exceed 70
diazoxide
oral hyperglycemia agent that inhibits pancreatic insulin secretion and glucose uptake by tissue
how does glucocorticoid therapy work to help medically manage insulinoma
increases hepatic glucose production and decreases cellular glu uptake
what diet to feed insulinoma patient
small frequent meals
high protein
complex carbs
gold standard surgical mgmt for insulinoma
partial pancreatectomy
Describes syndrome of gastric acid hypersecretion, gastrointestinal ulceration & non–β-cell pancreatic tumors
zollinger-ellison syndrome
gastrinoma diagnostic
high serum gastrin levels
